Cervical Spine Anatomy and Treatment Techniques PDF

CERVICAL SPINE Spinal Treatment FT 300/ PT 600 Student Learning Outcomes At the end of this class, learners will be able to do the following: Review cervical anatomy & biomechanics Perform assessments of the cervical spine Review common pathologies of the cervical spine Reading Assignment...

CERVICAL SPINE Spinal Treatment FT 300/ PT 600 Student Learning Outcomes At the end of this class, learners will be able to do the following: Review cervical anatomy & biomechanics Perform assessments of the cervical spine Review common pathologies of the cervical spine Reading Assignment 1. Magee Chapter 3 (Cervical) - p.148 Anatomy of the Cervical Spinal General Anatomy Stability sacrificed for mobility Vulnerable to injury as sits between heavy head & stable T- Spine Normal lordotic curvature of ~30-35°  Spinal Landmarks  Cervical Spine Divisions 1. Cervicoencephalic (C0-C2) 2. Cervicobrachial (C3-C7) 1. Cervicoencephalic (C0-C2) Injuries in this region potentially involve the brain, brainstem, and spinal cord Symptoms: headache, fatigue, vertigo, poor concentration, hypertonia of sympathetic nervous system, and irritability Atlanto-occipital joint (C0-C1) Principle motion: flexion-extension Atlanto-axial joint (C1-C2) Most mobile articulation in the spine Principle motion: rotation Main supporting ligament: transverse ligament of atlas Ligaments Alar ligament: Originates from lateral border of dens Transverse Ligament: Belongs to atlas and holds dens in place Cruciform: Two projections from transverse ligament 2. Cervicobrachial (C3-C7) Pain usually referred to upper extremity Neck pain, arm pain or both present Symptoms: headaches, restricted ROM, paresthesia, altered myotomes/dermatomes, radicular signs Vertebral Artery Passes through transverse processes of cervical vertebrae Usually starts C6 but enters as high as C4 Supplies 20% of blood supply along with internal carotid (80%) Lies close to facet joints and vertebral body Compression by osteophyte formation, facet injury Stressed by rotation, extension and traction Most common mechanism of injury (non-penetrating): neck extension with or without side flexion or rotation Symptoms may be delayed: Vertigo, drop attacks, nausea, tinnitus, visual disturbances Facet Joints Superior facets: face upward, backward, and medially Inferior facets: face downward, forward, and laterally facilitates FLX/EXT, but prevents simple rotation or side flexion without both occurring together (coupled movement) Greatest FLX/EXT of the facet joints: C5-C6 (C4-C5 & C6- C7) Degeneration is more likely to be seen at these levels. Facet Joints SPs at level of facet joints of same vertebrae First palpable SP is C2 Joints of Luschka Pseudojoints Between C3-C7 and develop with age Uncinate process above & uncus below Made as intervetebral discs degenerate Limits side flexion Cervical Nerve Roots Named for the vertebrae below it History Age Spondylosis often seen in persons 25 years of age or older Present in 60% of those older than 45 years and 85% of those older than 65 years of age Symptoms of osteoarthritis do not usually appear until a person is 60 years+ Pain Bone pain occurs immediately Muscle/lig pain immediate (e.g. tear) or delayed (e.g. MVA) Symptoms do not refer into arm for C4 nerve root injury or above Cervical radiculopathy (injury to nerve roots in spine) presents with unilateral muscle weakness (myotome), sensory alteration (dermatome) Disc herniation cause severe neck pain that may radiate into shoulder, scapula/arm, limit ROM, increase pain during coughing, sneezing, jarring or straining Observation Upper Crossed Syndrome Movement Protraction & Retraction Upper vs Lower Cervical Spine During FLEXION Upper cervical spine (C0-C2) nods Lower cervical spine (C2-C7) flexes Absence of one movement during flexion indicates restriction in that area Neurological Myotomes Referral Facet Joint – Referred Pain Pathologies Common Dysfunctions Whiplash Cervical Facet Irritation Brachial Plexus Injuries (Burners & Stingers) Torticollis Whiplash Associated Disorder (WAD) Acceleration-deceleration injury to the head and neck MVA, contact sports https://www.spine-health.com/video/whiplash-video Whiplash Associated Disorder (WAD) The Quebec Task Force (QTF) division of WAD: Grade 0: no neck pain, stiffness, or physical signs noticed Grade 1: neck complaints of pain, stiffness or tenderness only; no physical signs Grade 2: neck complaints and physical signs of decreased ROM and point tenderness in the neck Grade 3: neck complaints and neurological signs (decreased DTR, Brachial Plexus Injuries (Burners, Stingers) Blow to part of the brachial plexus or from stretching or compression of the brachial plexus Can be associated with MVA Torticollis "Wry Neck" Abnormal positioning of the head and neck relative to the body Typically head/neck side flexed to affected side; face turned away Involvement of levator scapula places head in extension Involvement of SCM places head in flexion Acute Acquired Torticollis Painful unilateral shortening or spasm of neck muscles resulting in abnormal head position May result from Activation of latent trigger points: Being left in short position (phone to ear, sleep position) Breeze chilling a muscle Subluxation of C1 on C2 (trauma related - whiplash) Facet Joint Irritation Infection Disc Related Pain Pseudotorticollis Type of acute acquired torticollis Painful limitation of all neck movement due to idiopathic global muscle spasm Person cannot move the head in any direction without pain Head is held in neutral No obvious onset of trauma Congenital Torticollis Contracture of one SCM resulting in abnormal head position Present from infancy Corrected by stretching or surgically May result from: Trauma in birth process causing inflammation and later fibrosing of SCM Malposition of fetus in utero Torsion of fetus's cranial bones Causes are idiopathic and not clearly understood Spasmodic Torticollis Localized dystonia resulting in involuntary spasm of cervical muscles and an abnormal head position Uncontrollable rhythmic spasm of neck muscles often worse when patient under stress May result from: Idiopathic (4/5 cases); linked to depression, stress CNS lesions Malformation of atlanto-occipital articulation Postural dysfunction (scoliosis) Trauma Special Tests Cervical Special Tests Spurling's (Foraminal Compression Test) Distraction Test Valsalva Shoulder Abduction Test (Bakody’s) Lateral Flexion Alar Ligament Stress Test Transverse Ligament Treatment Techniques Joint Play Movements Anterior Glide (Edmond, pg 249) Lateral Glide (Edmond pg 255) Vertebral Lateral Translations (Dixon, pg 22-23)